Obama’s Health Care Box

Alec MacGillis of the NewRepublic has been doing some fine campaign reporting this year and here he offers a smart look at what may be the most important state of all in November–Ohio. The most striking part of the piece for me, one that illuminates an essential conundrum for Barack Obama, occurs when MacGillis goes door to door with a labor-affiliated political organizer in a white working-class neighborhood in Columbus:

At the next house, a slightly chaotic scene swirled around James Tichenor, a 50-year-old who works at a local McDonald’s. A van missing a wheel sat jacked up on the driveway; an armchair lay on its side in front of the house; a 16-month-old boy, the son of Tichenor’s deceased niece, cried inside the house. [The organizer Theresa] Bruskin forged ahead, taking it in stride when Tichenor said he had no e-mail address (“I don’t know nothing about computers”) and that he could not give any money (“Right now, I’m pretty well busted”). He told me he wasn’t sure who he was voting for. I asked: Wouldn’t Obama’s health care law help him? He shook his head, saying he couldn’t afford the $51 per week bare-bones health plan offered by McDonald’s. I told him I was pretty sure that, if his employer didn’t offer decent, affordable coverage, he would qualify for Medicaid, which Obamacare will greatly expand. He said he’d never heard anything about that: He worked nights and didn’t watch the news.

But even if Tichenor watched the news, would he have learned about his rights under the Affordable Care Act? I doubt it. Indeed, the Obama Administration has been loath to advertise the most important provision of the bill: that the working poor would be eligible for free medical care or for health insurance stipends on a sliding progressive scale, according to income. Why hasn’t the President done this? Because the vast majority of Americans already have health insurance and are not too keen on giving out freebies in these tough economic times. A case can be made that they’re already paying for Mr. Tichenor’s health care: when he or his family members get sick, they undoubtedly show up at the local emergency room and the rest of us pay for it–but that’s a difficult case to make. It involves a compound sentence. It involves policy arcana. And it also involves a political calculation.

Obama’s advisers obviously have calculated that making a big deal out of free medical care for the working poor, and perhaps winning the support of marginal voters like Tichenor, would lose far too many middle class votes. And so the Obama campaign has emphasized more popular, if peripheral, aspects of the bill, like the provision that forces insurance companies to cover everyone, even those with chronic or pre-existing conditions; or the provision that allows children to stay on their parents’ health care plans until the age of 26.

I find this all very sad. The moral purpose of universal health care was to provide coverage for those hard-working Americans who don’t have the money to pay for it (Non-working Americans already receive coverage via Medicaid). If Obama is constrained from talking about the real reason for Obamacare because of a political calculation, it may pay some dividends in November. Or it may not: the President hasn’t sold his plan for what it actually is and so people, out in places like Ohio, understand neither the plan nor his reasons for pushing it. Those who oppose it fear the worst. Those who might benefit from it, and vote for the President, don’t understand the remarkable thing Obama has done for them.